Job details

Clinical Reimbursement Specialist/MDS Coordinator (RN)

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Description

We are seeking a highly organized person with strong time management skills to join our team as a Clinical Reimbursement Specialist who is a registered nurse. In this role you will responsible for overseeing a health center's RAI/Minimum Data Set and insurance authorization/coverage processes. This role does not have weekends, holidays or on-call and is located onsite.

If you are a highly motivated individual with a passion for people and a desire to make a difference, we encourage you to apply for this exciting opportunity. We offer competitive compensation, benefits, and professional development opportunities.

We would love to meet you!

Summary

Maintains and actively promotes effective communication with all individuals.
Maintains a positive image of the entity in the community keeping in alignment with our mission, vision, and values.
Responsible for on-call services, as assigned
Will ensure center adheres to Medicare coverage requirements; such as certification, assessment, and advance beneficiary notice.
Will oversee the Medicare meeting and provide direction to support process improvement.
Will oversee and assure accuracy/quality of the MDS/RAI process, including scheduling, completion and content.
Will be responsible to review 24 hr. report, physician orders, stand up meeting minutes daily, and monitor for any resident MDS/insurance coverage issues.
Will manage all requirements to authorize coverage & continued stay from HMO, Insurance, and LTC Policies.
Will maintain a strong working relationship therapy to determine assessment reference dates, insurance coverage criteria, and patient rehabilitative plan of care.
Performs other duties, as assigned.

Requirements

Current licensure to practice in Wisconsin as a Registered Nurse.
AANAC Resident Assessment Coordinator Certification Preferred.
4-5 years of experience in Minimum Data Set preferred.
Ability to navigate and effectively utilize an Electronic Medical Record program
Current CPR certification
Commitment to quality outcomes and services for all individuals.
Ability to relate well to all individuals.
Ability to maintain and protect the confidentiality of information.
Ability to exercise independent judgment and make sound decisions.
Ability to adapt to change.

Benefits

Health, Dental, & Vision Insurance
Health Saving Account with Potential Company Contributions
401(k) with Company Match
Financial and Retirement Planning at No Charge
Paid Time Off and Holidays
Basic Life Insurance & AD&D - Company Paid
Short and Long Term Disability - Company Paid
Voluntary Ancillary Coverage
Referral Bonuses
Employee Assistance Program

Illuminus is a faith-based, not-for-profit senior living management company dedicated to serving older adults and families throughout the Midwest with skill and compassion. We own or manage over a dozen communities in Wisconsin and beyond, offering independent senior housing, assisted living and memory care, skilled nursing and rehabilitation, low-income senior housing, home health and hospice services via Commonheart, management support and consulting.

The people of Illuminus are not just our colleagues, our employees, our residents—they are our parents, our grandparents, our partners, ourselves. We serve others with gratitude, dignity, hope and purpose. We believe that the right care can and will transform us all

Average salary estimate

$72500 / YEARLY (est.)

min

max

$65000K

$80000K

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What You Should Know About Clinical Reimbursement Specialist/MDS Coordinator (RN), Illuminus

If you're a compassionate and organized individual with a nursing background, we want you to consider joining Illuminus as a Clinical Reimbursement Specialist/MDS Coordinator (RN) right here in Milwaukee, Wisconsin! This role is perfect for someone who thrives in a supportive team environment, valuing communication and connection with both colleagues and residents. You will play a pivotal role in overseeing the RAI/Minimum Data Set and managing insurance authorization coverage processes, ensuring everything runs smoothly and effectively. The best part? This position offers a great work-life balance with no weekends, holidays, or on-call duties, allowing you to focus on what truly matters—helping people. We believe in fostering a supportive workplace culture that aligns with our mission, vision, and values, and we're committed to providing competitive compensation and professional development opportunities. Your responsibilities will include coordinating Medicare coverage requirements, overseeing the accuracy of the MDS/RAI process, and managing relationships with therapy teams to ensure an optimal rehabilitative plan for our residents. If you possess a current Wisconsin RN license, have experience with the Minimum Data Set, and share our dedication to quality care, we eagerly await your application. Come be a part of something meaningful at Illuminus where every day is an opportunity to make a difference!

Frequently Asked Questions (FAQs) for Clinical Reimbursement Specialist/MDS Coordinator (RN) Role at Illuminus

What does a Clinical Reimbursement Specialist/MDS Coordinator (RN) do at Illuminus?

At Illuminus, a Clinical Reimbursement Specialist/MDS Coordinator (RN) is responsible for ensuring compliance with Medicare coverage requirements, coordinating the Minimum Data Set and RAI processes, and maintaining effective communication with all team members. This role is crucial for managing insurance authorizations, ensuring residents receive the best care possible while aligning with the organization's mission and values.